MEASURING UNMET NEEDS FOR COMMUNITY-DWELLING CONSUMERS OF HOME- AND COMMUNITY-BASED SERVICES USING NCI-AD DATA

Abstract Rebalancing efforts have focused on helping more people age in the community rather than institutional settings. Yet, we know little of whether actual services being offered meet consumer needs. HCBS provides intermittent services and supports to consumers and variability can create increased reliance on informal caregivers, contributing to unmet need. This can be especially true for consumers living with Alzheimer’s disease and Alzheimer’s disease and related dementias (AD/ADRD), whose needs may fluctuate and intensify as functional and/or cognitive impairments advance. This presentation examines unmet need among a national sample of older adult (65+) consumers of publicly funded HCBS, using data from the National Core Indicators - Aging and Disability (NCI-AD) survey from 2016-2019. We restrict our sample to community-dwelling older adults, where community-dwelling includes: own or family house/apartment, senior living apartment/complex, group home, adult family home, foster, or host home. Our results showed that services that were most commonly used were home-based services (57%), with at least half of the consumers using two different services to support their needs. Factors associated with wanting more services included being a woman, living alone, having a physical disability, and a diagnosis of AD/ADRD. Older adults with AD/ADRD desired more services than those without AD/ADRD, with additional desired services for caregiver supports and transportation. Our findings speak to the need to measure and improve person-centered quality of publicly-funded HCBS for older adults, with particular attention to the needs of those living with AD/ADRD.

Tuscaloosa, Alabama, United States,3. School of Social Work,The University of Alabama,Tuscalossa,Alabama,United States,4.The University of Alabama,Tuscaloosa,Alabama,United States,5. University of Texas Health Science Center,San Antonio,Texas,United States Over the past few decades, research on quality of life at the end of life has proliferated, with an increased focus on issues of diversity.However, few studies have considered the impact of multiple disadvantaged identities, including the combination of race and gender.This study assessed the intersectional impact of race and gender on four end-of-life outcomes: pain, anxiety/depression, patient autonomy, and overall care quality.Data were derived from the combined 2012 to 2020 last-month-of-life interviews conducted by the National Health and Aging Trends, which is an annual longitudinal panel survey of Medicare beneficiaries aged 65 and older.Multivariate logistic regression models were used to test the association between the race/gender intersection and each of the four outcomes.Results showed that Black women were the most likely to be in pain, most likely to have a lack of autonomy in decision-making, and the least likely to have excellent or good care at the end of life.White women were the most likely to have had anxiety/depression, followed by Black women, Black men, and then White men.Across all four outcomes, White men were the most likely to have had favorable outcomes, confirming the theory of intersectionality.These results point to a significant disparity in quality end-of-life care for Black women, who have double-jeopardy as a result of their membership in two vulnerable groups.Thus, there is increased need for practice, policy, and research interventions to attain equitable end-of-life care for all individuals.

SOCIAL INEQUITIES AND THE IMPAIRMENT PARADOX IN LATER LIFE
Michal Engelman 1 , and Heide Jackson 2 , 1. University of Madison,Wisconsin,United States,2. University of Maryland,College Park,Maryland,United Sta tes Research on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life.This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory.Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities.Using the Health and Retirement Study, we characterize the functional impairment histories of a nationally representative sample of 8464 older adults between 1994 and 2016.We employ nonparametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition.As expected, exposures to disadvantages are associated with poorer functional health in midlife and mortality.However, we find that a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for White men and women and for Black women, and the impact of educational attainment, occupation, wealth, and marriage on later-life health differs across race and gender groups.We conclude that the observed stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages.Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.

MEASURING QUALITY IN LONG-TERM SERVICES AND SUPPORTS THROUGH PERSON-REPORTED OUTCOMES: VALUE OF NCI DATA
Chair: Tetyana Shippee Co-Chair: Stephanie Giordano Long-Term Services and Supports (LTSS) include medical, social, and personal care services that people may need to perform activities of daily living due to physical or cognitive impairments.Measuring the quality of LTSS is essential for improving the care and outcomes of people with disabilities and older adults and ensuring that services meet consumer needs.Several frameworks have been developed to measure LTSS quality, including the National Quality Forum's LTSS Framework.Yet, few data sources are available to measure person-reported quality in HCBS.This symposium will provide an overview of National Core Indicators (NCI) as a unique data source to address this gap.It also includes presentations from researchers from organizations in two states who utilize NCI data -Minnesota and Massachusetts -who will share their perspectives about the value of the data, results from empirical analyses, and how they use and plan to use the data to inform policy.Researchers from the Lurie Institute for Disability Policy will present findings on the association between person-centered planning and key person-reported outcomes in Medicaid HCBS.Researchers from the University of Minnesota School of Public Health and Brown University will share findings from national NCI data on unmet needs among older adults by dementia status and race/ethnicity.They will also share results of analyses in MN, linking person-reported HCBS plan quality and healthcare utilization, using claims data.Collectively, this symposium will address the gap in measurement of HCBS quality nationally and identify key directions for policy and future research.
Abstract citation ID: igad104.0806Rebalancing efforts have focused on helping more people age in the community rather than institutional settings.Yet, we know little of whether actual services being offered meet consumer needs.HCBS provides intermittent services and supports to consumers and variability can create increased reliance on informal caregivers, contributing to unmet need.This can be especially true for consumers living with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), whose needs may fluctuate and intensify as functional and/or cognitive impairments advance.This presentation examines unmet need among a national sample of older adult (65+) consumers of publicly funded HCBS, using data from the National Core Indicators -Aging and Disability (NCI-AD) survey from 2016-2019.We restrict our sample to community-dwelling older adults, where communitydwelling includes: own or family house/apartment, senior living apartment/complex, group home, adult family home, foster, or host home.Our results showed that services that were most commonly used were home-based services (57%), with at least half of the consumers using two different services to support their needs.Factors associated with wanting more services included being a woman, living alone, having a physical disability, and a diagnosis of AD/ADRD.Older adults with AD/ADRD desired more services than those without AD/ADRD, with additional desired services for caregiver supports and transportation.Our findings speak to the need to measure and improve person-centered quality of publicly-funded HCBS for older adults, with particular attention to the needs of those living with AD/ADRD.Abstract citation ID: igad104.0807

USING NATIONAL CORE INDICATORS-AGING AND DISABILITIES-FOR QUALITY, POLICY, AND SYSTEM TRANSFORMATION Stephanie Giordano, Human Services Research Institute, Cambridge, Massachusetts, United States
National Core Indicators Aging and Disabilities (NCI-AD™), uses survey data to support State Medicaid, aging, and disability agencies to conduct surveys with individuals receiving publicly-funded long-term services and supports and measure and track their own outcomes and performance using reliable data collection methods and tools.Established in 2015, NCI-AD is now in use by 22 states nationwide.The NCI-AD portfolio includes the flagship survey -the Adult Consumer Survey (ACS) and the State of the Workforce-Aging and Disabilities (SotW-AD) survey.The ACS collects data directly from older adults and people with physical disabilities to assess the outcomes of services provided to individuals.Indicators address key areas of concern including service planning, rights, community inclusion, choice, health and care coordination, safety and relationships.In 2022, NCI-AD piloted the SotW-AD survey with five participating states.A first of its kind for the aging and disabilities field, this new effort collects and aggregates statewide information about wages, benefits, and turnover of the direct service workforce-as reported by the agencies that employ them.The SotW-AD will launch to all AD states in summer 2023.This session will provide an overview of the NCI-AD program, the type of data collected from each survey, and how state-level and research partners have utilized the data sets.
Abstract citation ID: igad104.0808Person-centered planning (PCP) allows home and community-based service (HCBS) users to plan and coordinate services and supports according to their preferences and needs.The extent to which HCBS systems provide high-quality PCP and evidence for the relationship between PCP and user outcomes is limited.This study examines HCBS user characteristics related to PCP and the association between PCP and both unmet need and community living.We used the 2018-2019 National Core Indicators-Aging and Disability survey's Person-Centered Planning Module, collected among adult Medicaid HCBS users in 12 states (n = 6,924).Independent variables included two general PCP measures (one on decision-making and another on preferences and choices being reflected in service plans) and a PCP fidelity scale to assess the extent to which users' most recent service planning meeting was person-centered.Outcomes included two measures of unmet need for services and three measures of community living (i.e., participation, control, and satisfaction).We examined user characteristics associated with PCP and used logistic regression models to assess the relationship between PCP and outcomes.About 85% of users reported they were fully involved in decision-making, 77% reported their preferences and choices were reflected in their service plan, and 57% had their most recent service planning meeting coded as "high fidelity" on the PCP fidelity scale.Each marker of high-quality PCP was consistently related to lower likelihood of unmet need and greater likelihood of experiencing each community living outcomes.Findings suggest high-quality PCP is important for meeting HCBS users' needs and improving community living outcomes.Providing high quality home and community-based services (HCBS) to older adults is a priority, but surprisingly little is known about the association between HCBS quality and client health care utilization.We linked data from the 2018 wave of the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey for participants in the State of Minnesota enrolled in the Elderly Waiver (n=1,449) to their Centers for Medicare and Medicaid Services (i.e., claims data).We attributed respondents in our sample to 1 of 8 managed care organizations (MCOs) responsible for managing the health and HCBS of

THE ASSOCIATION BETWEEN PERSON-CENTERED PLANNING AND PERSON-REPORTED OUTCOMES IN HOME-AND COMMUNITY-BASED SERVICES
Tetyana Shippee 1 , Taylor Bucy 2 , John Mulcahy 1 , and Eric Jutkowitz 3 , 1. University of Minnesota, Minneapolis, Minnesota, United States, 2. University of Minnesota School of Public Health, Minneapolis, Minnesota, United States, 3. Brown University, Providence, Rhode Island, United States Natalie Chong 1 , and Joseph Caldwell 2 , 1.The Heller School for Social Policy and Management at Brandeis University,